American College of Physicians: Internal Medicine — Doctors for Adults ®

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COPD is high on mortality, low on public recognition

Campaign urges those at risk to get checked and asks physicians to be more vigilant about screening

From the October ACP Observer, copyright 2006 by the American College of Physicians.

By Stacey Butterfield

Chronic Obstructive Pulmonary Disorder (COPD) has an image problem. It is the fourth leading cause of death and has been diagnosed in about 12 million people in the U.S., yet most Americans have never heard of it.

“Despite the best efforts of many organizations, including the NIH, the public has little knowledge of COPD,” said James Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI).

Dr. Kiley and others at the NHLBI are trying to change that with a public education campaign aimed at reaching those at risk for COPD, mainly current and former smokers and others who may have a genetic predisposition to the disease. The NHLBI hopes the campaign will do for COPD what the "Heart Truth” campaign did for raising awareness of heart disease among women.

COPD is the only one of the leading killer diseases with a rising mortality rate. From 1965 to 1998, the death rate from COPD grew 163%. “If nothing is done, the COPD epidemic may continue to get worse for another 10 or 20 years,” said Dr. Kiley.

Statistics such as these have gotten little coverage until now, partly because COPD’s major risk factor, causing about 85 percent of cases, is cigarette smoking. In the past, attention was focused mainly on smoking cessation, rather than diagnosis and treatment of COPD. These efforts have been somewhat successful at reducing smoking rates, Dr. Kiley said, "but the fact is, that if we focus solely on the smoking cessation message, we’re not doing anything for the former smoker who already has the disease.”

COPD, an incurable disease, has also gained a reputation as a problem that can't be solved. But that situation is changing. Several years ago, the NHLBI began efforts to increase research on COPD and to move new knowledge into clinical practice.

COPD is caused by exposure to particles and gases (not only cigarette smoke, but also fumes, indoor pollution and dust). Viral and bacterial infections may also play a role, and alpha-1 antitrypsin deficiency has been identified as a genetic risk factor. The NHLBI’s COPD Clinical Research Network is currently testing new treatments, but in the meantime, said Dr. Kiley, physicians need to know that there are simple ways to diagnose and manage the disease.

COPD is often difficult to diagnose because patients sometimes neglect to mention breathing problems to their physician and try—sometimes unconsciously—to correct the problem by modifying their behavior. They cut back on recreational exercise or take an elevator where they used to walk the stairs. To uncover symptoms, the physician may have to compare a patient’s current level of activity with past activities.

The COPD campaign aims to tackle the problem from both sides. The public aspect of the campaign will encourage people to take notice of their symptoms and see a physician. At the same time, it will urge physicians to thoroughly investigate at-risk patients. “Ask the questions," said Dr. Kiley. "Probe to see if the patient is having symptoms.”

Once patients are identified as possibly having COPD, he recommends spirometry as the tool of choice for diagnosis. After diagnosis, various treatments have been shown to improve quality of life and survival for COPD patients. Treatment options include lifestyle changes, drug treatments, pulmonary rehabilitation and oxygen supplementation. Smoking cessation remains the only way to prevent progression of the disease.

The awareness campaign, dubbed “Learn More Breathe Better,” was launched in late September at the American Academy of Family Physicians Scientific Conference. It was the first in a series of presentations that campaign organizers plan to give to physicians before taking their message to the public, said Garry Curtis, a campaign spokesperson. The public outreach effort is scheduled to begin in January 2007 with print and radio public service announcements. The ads will encourage at-risk individuals to visit a physician for a checkup and possible spirometry.

For health professionals, the NHLBI is producing a pocket reminder card to assist with diagnosis and treatment of COPD. Hospitals and physicians will also be able to order patient education materials, including brochures and posters, on the campaign’s website. Over the next three years, the campaign will publicize new COPD research findings through major media outlets and presentations to physician associations.

The most important aspect of the campaign is the participation of individual physicians, said Dr. Kiley. “The physicians who are on the front lines dealing with this type of patient are critical to the success of the campaign," he said. "We need to turn the table on this increasing cause of disability and death.”

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